Provider Demographics
NPI:1326710344
Name:PORTNOY, JARED COREY (DC)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:COREY
Last Name:PORTNOY
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 E ATLANTIC BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-6741
Mailing Address - Country:US
Mailing Address - Phone:754-205-6865
Mailing Address - Fax:
Practice Address - Street 1:1380 N UNIVERSITY DR STE 103
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4719
Practice Address - Country:US
Practice Address - Phone:954-975-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH13680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor